Better Vision Without Looking Your Age

MANY baby boomers who grew up wearing contact lenses thought they were liberated from glasses forever. But sometime between the 40th and 50th birthdays a cruel reality sets in. Suddenly the type in the newspaper is smaller. The controls on the car dashboard are blurry. Menus and price tags become illegible.

Perish the thought, but they need glasses again — only this time it’s the cheap plastic readers at the end of the pharmacy aisle. People who once brushed by the displays thinking “those are for old people” find themselves hijacking a pair to read the recommended dose on a bottle of antacid.

Wearing and removing granny glasses throughout the day (or having them permanently perched halfway down the nose), never seemed to bother their parents, but the generation born between 1946 and 1964 takes it as an affront to its youth oriented style.

Barbara Reno, a vice president and managing director with the Conference Board in Brussels, couldn’t fit the glasses in the small handbags she favors, so never had them when needed. Idrienne Steiman-Weidberg, a Pilates teacher with her own studio in Indianapolis, hated the way she looked with the glasses dangling from her neck, but she couldn’t book appointments without them. Robert J. Reicher, a lawyer with his own practice in New York, misplaced his reading glasses so many times that he started buying them in bulk at Costco.

But now there is a new development in contact lenses that makes it possible to see close, far and in between, without glasses. It is the latest option available to deal with presbyopia, the gradual deterioration of close vision, and more options are on the horizon.

The contact lenses that correct distant, intermediate and near vision are called multifocal lenses, and though they have been around for about 10 years, they have been vastly improved recently. Computer technology has made it possible to fine-tune manufacturing. And optometrists and ophthalmologists have become more experienced with prescriptions and fittings, leading to less inconvenience and better results.

When fitted correctly, multifocal lenses allow the wearer to see clearly at every distance without moving or even tilting the head, though vision may not be as crisp as with other alternatives.

Most of the new lenses are aspheric, meaning they have three prescriptions arranged in concentric circles like a bull’s-eye — typically with distance in the middle, intermediate vision next, and near vision in the outer circle.

Multifocals come in soft lenses, which are known for their comfort, and in rigid gas permeable lenses, which produce sharper vision. Although some people require custom contact lenses to correct presbyopia, many others can choose from an assortment of off-the-shelf soft products, available in a two-week or 30-day disposable version.

The price range for a one-year supply generally is $200 to $500, depending on the type of lens and the degree of customization. A bigger expense may be the cost of fitting the lenses, which can vary depending on the complexity of a case and the number of visits. It can range from a modest insurance plan co-payment to about $1,000.

Most of the specialists in this field are optometrists. Often they stock samples from various manufacturers, enabling patients to try them in the office and then take them home for a test. (There’s typically a 90-day return or exchange policy.)

Barry J. Farkas, an optometrist in New York who tests these products for the major manufacturers, said his success rate for presbyopic patients is 75 to 80 percent for gas permeable lenses, and 60 to 70 percent for soft lenses. (Less experienced prescribers may have slightly lower rates.) It takes a week or two to get used to the lenses, he said, and some people still need a supplemental pair of reading glasses for certain tasks, especially if the light is low.

After Mr. Reicher, the lawyer, had been wearing multifocal lenses for two years, he started noticing that he needed more light to read. His doctor decreased his distance prescription so he would see better up close. That’s a typical trade-off with multifocal lenses, experts said, and Mr. Reicher decided he could live with it. “The only time I notice it is with road signs or if I have a bad seat in the theater,” he said.

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One alternative to multifocals is monovision, in which one eye (usually the dominant one) is fitted with a contact lens to see distance and the other is fitted with a lens to see close. An advantage of monovision is that if you can get used to it (only about half the population can), you can have perfect distance vision and perfect near vision — just not in both eyes, Dr. Farkas said.

When Ms. Steiman-Weidberg, the Pilates teacher, first tried monovision, she felt so dizzy and disoriented that she abandoned the effort after a week and went back to wearing reading glasses over her contact lenses. But two years later, after her near vision worsened, she tried again.

This time she easily adapted, but her tennis game suffered: as the ball came closer, her near vision kicked in and everything blurred. She now switches the lens she uses for reading to a distance lens when she is going to play tennis or watch a movie.

It’s also possible to achieve monovision correction surgically, said Richard Braunstein, director of refractive surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center. This works especially well with patients who have already used monovision in contacts.

But the procedure may only be a temporary fix, Dr. Braunstein said. Because presbyopia continues to worsen for 15 to 20 years, people who have the surgery in their 40s will probably need reading glasses later on.

Monovision in any form wasn’t an option for Peter Bermant because he has one eye that strongly dominates. He corrects his vision with another configuration, a bifocal lens, which is similar to bifocal eyeglasses, with distance vision corrected in the top half and near vision corrected in the lower part.

Mr. Bermant said his gas permeable bifocal lenses give him the excellent near vision he needs for his work as an accountant with Anchin, Block & Anchin in New York.

But getting the lens just right took some fine-tuning. As the lens shifted, Mr. Bermant didn’t have the benefit of the reading portion on the bottom. His optometrist changed the shape slightly, to make the reading section thicker and prevent it from moving. But over all the success rate is 40 to 50 percent, Dr. Farkas estimated.

Some people can’t wear contact lenses. About 5 to 10 percent of the population has severe allergies or other medical conditions that make it impossible to tolerate the lenses, said Paul Super, an optometrist in Los Angeles. Dry eyes, a condition that becomes more prevalent as people age, can also be an impediment.

For those who don’t succeed with contact lenses, and maybe even for those who do, new procedures and products that address presbyopia are being developed. Presbyopic laser correction is in clinical trials, Dr. Braunstein said. And lens implants, routinely used for people already undergoing cataract surgery, can provide correction both near and distant, freeing them from wearing glasses. The Food and Drug Administration has not yet approved implants for non-cataract use.

The demand among baby boomers for sight correction “is extraordinary,” Dr. Braunstein said. And even more than vanity, it’s a matter of utility.

People are living longer, working longer and leading more active lives, he said. “They want to function as they age like they did when they were young.”

A version of this article appears in print on , on Page G3 of the New York edition with the headline: Better Vision Without Looking Your Age. Order Reprints|Today's Paper|Subscribe